Multi-fit orthotic and mobility assistance apparatus

ABSTRACT

A multi-fit orthotic structure including an attachment system for coupling the orthotic structure to a wide variety of subjects without requiring a custom fit. In one embodiment, active mobility assistance is provided via an orthotic system capable of integrating a linear actuator and linkage system to deliver torque to the lower leg of a subject to facilitate flexion and/or extension motion of the subject&#39;s leg. The orthotic structure is attached to the subject using a textile suspension system which does not require the orthotic structure to interface directly in the knee region or at the lateral areas of the thigh and calf of the subject, thus providing an ideal fit for the widest possible range of subjects with the minimum number of required sizes.

CROSS REFERENCE TO RELATED APPLICATIONS

The present patent application claims priority to as a continuation andincorporates by reference U.S. patent application Ser. No. 12/366,998,entitled “Multi-Fit Orthotic and Mobility Assistance Apparatus”, filedon Feb. 6, 2009, now U.S. Pat. No. 8,052,529 which claims priority toand incorporates by reference the corresponding provisional patentapplication Ser. No. 61/027,365, entitled, “Multi-Fit Orthotic andMobility Assistance Apparatus” filed on Feb. 8, 2008.

FIELD

At least certain embodiments of the invention relate generally tofunctional rehabilitation and mobility enhancement of patients who havesuffered loss of function due to injury, disease or other condition, andmore particularly, but not exclusively, to orthotic devices forfunctional rehabilitation.

BACKGROUND

Devices to assist individuals with impaired mobility due to illness orinjury include passive and active assistance and support devices,mobility devices and strength training devices. Passive assistance andsupport devices, such as canes, crutches, walkers and manualwheelchairs, provide assistance with mobility. However, individualsusing such devices must supply all of the power needed by exertingforces with other muscles to compensate for the muscle that is weak orinjured. Additionally, many passive assistance and support devicesprovide limited mobility.

Many types of existing passive knee braces are available for stabilizingthe knee to prevent or recover from injury, or to provide stability forchronic conditions. Existing braces typically come in either a fewstandard sizes or are custom-fitted to each patient. The standard sizesoften cannot conform closely to the unique shape of an individual legand may suffer from poor fit. The custom-fitted braces are expensive andcannot be re-used by other patients after the brace is no longer needed.Both types of brace typically rely on the tightness of fit to keep themfrom sliding down the leg. Keeping these braces in the proper positionis a largely unmet problem.

Existing orthotic designs have many points of structural contact withthe subject's body. Each contact point must be custom molded to aspecific shape to meet the wide array of dimensions and geometries ofsubjects. Otherwise, the points of contact will be sub-optimal and willresult in discomfort and pain. Additionally, existing knee braces havenot been designed to couple with actuators to provide active assistance.Most passive braces do not have the required structure or attachmentpoints to allow an actuator to be coupled.

Moreover, existing devices such as continuous passive motion (CPM)machines and robotic therapy devices involve the use of an externalforce to flex and extend a subject's limb to induce motion. Continuouspassive motion of a joint following injury, illness or surgery has beenfound to reduce the post-operative pain, decrease adhesions, decreasemuscle atrophy, and enhance the speed of recovery, while minimizingvarious risks of mobilization. CPM machines slowly and gently move asubject's leg through a reciprocal cycle between a flexion position inwhich an angle between the subject's femur and tibia is at a minimum,and an extension in position in which the angle between the subject'sfemur and the tibia is at a maximum. However, CPM machines are notsufficiently small and light as to allow attachment directly to asubject's leg (or other body part) and do not allow for mobility,typically requiring the subject to be in the reclined or sittingposition during operation.

SUMMARY OF THE DISCLOSURE

At least certain embodiments of the invention disclose methods andapparatuses including a multi-fit orthotic structure with an attachmentsystem for coupling the orthotic structure to a wide variety of subjectswithout requiring a custom fit. In one embodiment, active mobilityassistance is provided via an orthotic system capable of integrating alinear actuator and linkage system to deliver torque to the lower leg ofa subject to facilitate flexion and/or extension motion of the subject'sleg. The orthotic structure is attached to the subject using a textilesuspension system which does not require the orthotic structure tointerface directly in the knee region or at the lateral areas of thethigh and calf of the subject, thus providing an ideal fit for thewidest possible range of subjects with the minimum number of requiredsizes. The multi-fit orthotic structure also allows a single device tobe worn on either the right or left leg. Additionally, a textilesuspension system may be integrated into the attachment system todynamically adapt to a wide range of subject's geometries.

BRIEF DESCRIPTION OF THE DRAWINGS

A better understanding of at least certain embodiments of the inventioncan be obtained from the following detailed description in conjunctionwith the following drawings, in which:

FIG. 1 is a side-viewed diagram of an orthotic system according to anexemplary embodiment of the invention;

FIG. 2 shows a configuration of the tibia alignment and lengthadjustment system according to an exemplary embodiment of the invention;

FIG. 3 illustrates examples of an orthotic system superimposed onsubjects with varying degrees of leg alignment; and

FIG. 4 illustrates a configuration of a thigh and knee textiletensioning system according to an exemplary embodiment of the invention;

FIG. 5 illustrates a configuration of a lower shin textile tensioningsystem according to an exemplary embodiment of the invention; and

FIG. 6 illustrates a cross-sectional view of a thigh suspensionmechanism according to an exemplary embodiment of the invention.

DETAILED DESCRIPTION

Throughout the description, for the purposes of explanation, numerousspecific details are set forth in order to provide a thoroughunderstanding of the present invention. It will be apparent to oneskilled in the art, however, that the present invention may be practicedwithout some of these specific details. In other instances, well-knownstructures and devices are shown in block diagram form to avoidobscuring the underlying principles of embodiments of the invention.

Embodiments described herein include a relatively inexpensive orthoticsystem for functional rehabilitation of patients who have suffered lossof function due to illness or injury. The orthotic system is designed toconform closely to the unique shape of an individual subject's legwithout requiring the expense of a custom fit, while being provided inthe fewest possible sizes that accommodate the widest range of subjects.Additionally, the orthotic system described herein limits the points ofstructural contact of the primary orthotic structure to at most two (2)contacts: one on the proximal thigh and the other on the distal shin.This arrangement accommodates the shapes and sizes of a wide varietysubject's appendages which occur between the two (2) contact points. Byusing a suspension textile with the ability to support, pad, and lockonto the subject, the structure is provided with the points of leverageand support required to constrain movement and assist as an exoskeleton.Embodiments are capable of attachment directly to the leg to provide notonly support, but active mobility assistance in addition to continuouspassive motion and robotic therapy. Embodiments also accommodate acenter mounted linear actuator and bell crank linkage coupled to thelower leg orthotic structure. Center mounting of the actuator along withthe adjustability of the orthotic system allow the same device to fiteither the right or left leg. A unified design eliminates, the costsassociated with the development, manufacturing and inventory, ofdifferent devices for each leg.

FIG. 1 illustrates a side-view diagram of an orthotic system accordingto an exemplary embodiment of the invention. In the illustratedembodiment, orthotic system 100 includes: linear actuator 1; bell crank2; thigh orthotic structure 3; lower leg orthotic structure 4; tibiaanterior structure 5; tibia posterior structure 6; connector link 7;hinge 8; tibia suspension system 9; lateral support structures 10; anklesuspension structure 11; footpad sensor, system 12; lower leg textiles13; thigh textile 14; upper shin textile 15; toe strap 26; and anti-footdrop system 27. However, this is given by way of example and notlimitation, as the orthotic system described herein may include fewer ormore components. Linear actuator 1 acts directly on a linkage point of abell crank rocker arm 2. The linear actuator 1 is mounted on a pivot 101at the upper most end of the thigh orthotic structure 3; however, otherembodiments would include the linear actuator 1 being constrained on afixed plane or fixed via pivot on any portion of the thigh orthoticstructure 3 or lower leg orthotic structure 4 or other structural parts.Alternate embodiments would also include indirect actuation via an inputlink between the linear actuator 1 and the bell crank 2.

The bell crank 2 has one or more fixed pivots 103 on the same structureas the linear actuator 1 is mounted. In one embodiment, the bell crank 2has dual fixed pivots 103, both in a coaxial configuration with respectto one another on opposite lateral sides of the orthotic system 100. Thelinear actuator 1 operates on a point at or near the midline of both theorthotic system 100 and the bell crank 2 to split the forces into two(2) nearly equal components to balance torque transferred to the lowerstructure. The bell crank 2 has two (2) output pivots 105 in the samelateral plane as the bell crank pivots 103; however, an alternateembodiment could have fewer or more output pivots 105 which are notnecessarily aligned with the bell crank pivots 103. At least certainembodiments utilize two (2) link structures 7 which transfer forces toand from the lower orthotic structure 4. The thigh orthotic structure 3is connected to the lower leg orthotic structure 4 using one or morehinge joints 8. In one embodiment, the hinge joints 8 are located oneach lateral side of the orthotic system 100 such that they can beplaced in a coaxial configuration relative to the joint of the subjectwearing the orthotic system 100. The orthotic system 100 uses a gearedpolycentric hinge joint 8; however, alternate embodiments may includethe use of single pivot joints as well as other linkage systems (such asa crossed four-bar linkage or other similar multi-axis joints). The linkstructures 7 act on individual pivots 107 on the lower leg structure 4;however, other embodiments include fewer or more pivots 107 or sphericaljoints.

In the illustrated embodiment, the distal portion of the tibia posteriorstructure 6 is affixed to the tibia suspension system 9 such that highlevels of force may be transmitted to the top of the lateral supportstructures 10 positioned on each of the lateral sides of the lower legof the subject. The lateral support structures 10 transmit forcesvertically to the ankle suspension structure 11 and ultimately to theground via the foot pad sensor system 12. The lateral support structuresare attached to the lower leg textiles 13 which hold each of the lowerleg components relative to one another and provide wide area support tothe subject's body as well as padding between hard structures and thebody. In one embodiment, the thigh textile 14 is attached to the thighorthotic structure 3 at two (2) points at the proximal end of thestructure as well as two (2) points laterally near each of the hinges 8.Alternate embodiments include the thigh textile 14 to be attached at oneor more points at the distal end of the thigh orthotic structure 3 aswell as one or more points at the proximal end of the thigh orthoticstructure 3. In one embodiment, the upper shin textile 15 is affixed tothe lower leg orthotic structure 4 at two (2) lateral points near eachhinge. Other embodiments include affixing the upper shin textile 15 infewer or more places.

The tibia suspension system 9 is embodied as an adjustable webbing strapwhich connects the distal end of the tibia posterior structure 6 and theproximal end of the lateral support structures 10. Alternate embodimentsmay include a combination of vertical force carrying tension structureswhich transfer force from any point on the tibia length system orsimilar anterior structure to any point on lateral structures similar tothe lateral support structures 10. The foot pad sensor system 12 may beembodied by four (4) pressure sensitive sensors encased in textile. Inat least certain embodiments, two sensors are located in the forefootarea and two are located under the heel of the subject. The design issuch that the foot pad sensor can be reversed to accommodate both leftand right feet. An optional toe strap 26 is similarly reversible left toright and allows the footpad to be secured to the foot to eliminate atripping hazard as well as giving a point of attachment for anti-footdrop system 27.

The illustrated embodiment includes a passive foot drop tension system27 which may be embodied as elastic webbing connecting the forefoot loopwith the lower portion of the tibia posterior structure 6. Alternateembodiments may include active foot drop devices including linear androtational actuators placed inline between the toe strap 26 and thedistal portion of the tibia posterior structure 6 or which could behydraulic, pneumatic, electric, or remotely actuated via cable.Alternate embodiments of the foot pad sensor system 12 include anynumber of sensors placed throughout the footpad. Additional embodimentsof the pressure sensors in the orthotic design include placement ofpressure sensors in anterior and posterior portions of the textiles aswell as directly on the posterior side of the orthotic system facing thesubject to facilitate determining the level of pressure and forces ofexerted in and around these interfaces, and to automatically instruct orwarn the subject of potential problems as well as facilitate using, forexample, the pressure and force information as predictive feedback tosoftware of the linear actuator for gait analysis.

FIG. 2 shows a configuration of the tibia alignment and lengthadjustment system according to an exemplary embodiment of the invention.The tibia alignment and length adjustment system is integrated into thelower leg orthotic structure 4, the tibia anterior structure 5 and thetibia posterior structure 6. The tibia anterior structure 5 can berotated about a point 209 on the midline of the device's lower legorthotic structure 4. A structure with two (2) slots 211 which haveconstant radii about the center point allow two (2) bolts to passthrough and allow the lower leg orthotic structure 4 to be coupled withthe tibia anterior structure 5. This system allows the structures 4 and5 attached to the tibia anterior structure 6 to rotate relative thethigh orthotic structure 3 and the lower leg orthotic structure 4.Alternate embodiments include a single radius slot rotating about afixed point, multi-position bolt or circular structures. The tibialength system includes three (3) slots oriented along theproximal/distal axis, two (2) slots 213 in the distal portion of thetibia anterior structure 5 and one (1) slot 215 in the proximal end ofthe tibia posterior structure 6. When bolts through these slots areloosened, the tibia posterior structure 6 is allowed to move distally orproximally to adjust the length of the tibia posterior structure 6relative to the proximal structures. Orthotic system 100 allows thetibia structures 5 attached to the tibia anterior structure 6 to rotaterelative the thigh orthotic structure 3 and the lower leg orthoticstructure 4 to accommodate subjects with non-linear leg structurealignment such as those depicted in FIG. 3, which illustrates examplesof an orthotic system superimposed on subjects with varying degrees ofleg alignment including nominal leg alignment as well as an extremebowlegged subject and a knock-kneed subject.

FIG. 4 illustrates a configuration of a thigh and knee textiletensioning system according to an exemplary embodiment of the invention.One embodiment utilizes zipper closure 16 for the upper textile portionsof the system; however, alternate embodiments could implement hook andloop, button, snap, or other similar fasteners to close and tighten thetextile system. Independent cable reel tensioning systems 18 and 19 areimplemented in the thigh textile system 14 to adjust tension across abroad surface area of the skin and soundly secure the orthotic system100 to the subject. The cable reel tensioning system implements, two (2)independent cable reels into the thigh textile system 14; however,alternate embodiments of the design can implement fewer or more cablereels (or fabric/webbing roller furling systems) to take up slack in thethigh textile 14 to affect textile tension and the fit of the orthoticto the subject. Additional embodiments of the tensioning system mayinclude integration of pneumatic cells into the textile which can bestatically inflated to a particular level to adjust fit to the subjector can be inflated dynamically through an inflation system (or viaorthotic motion to dynamically massage the subject's appendage to assistin blood circulation through the appendage).

The illustrated embodiment of FIG. 4 includes a knee-lock tensioningsystem comprised of a cable reel system with loops of cable 21/22exiting and entering the independent cable reel 19. The cable loop isrouted such that one direction of the cable loop is routed along theanterior portion of both the proximal and distal sections of thesubject's knee creating the anterior knee lock cable loop 21. The otherdirection of the same cable is routed along the posterior of theproximal and distal portions of the subject's knee while avoiding thearea directly behind the knee to create the posterior knee lock cableloop 22. The cable is isolated by an isolating nut 23 such that thelengths of the anterior and posterior loops 21/22 of the knee locksystem are maintained without affecting one another. The isolation nut23 can be loosened to adjust the relative amount of cable in each of theposterior and anterior loops of cable. Alternate embodiments couldimplement webbing furling or webbing ratcheting systems to affect thesame locking phenomenon. The knee lock system when adjusted properlylocates the subject's knee joint axis in a coaxial configuration withthe hinge joints 8 of the orthotic system 100.

The illustrated embodiment of FIG. 4 also includes a proximal thightensioning system. The independent proximal thigh cable reel 18 may bedesigned to induce tension and a solid, stable interface between thesubject's proximal thigh and the thigh orthotic structure at theproximal end of the structure, off of which leverage may be gained whenapplying torque to the subject's leg. The proximal thigh tension cable24 forms two (2) loops which cover a broad area and distribute forceevenly throughout the textile. The orthotic structure has clearance nearthe knee and does not require structural elements in close proximity tothe kneecap. This design prevents the orthotic from applying unwantedforces to the knee. The clearance allows for post-surgical bandages andallows icepacks to be applied and removed while the orthotic remains inplace.

FIG. 5 illustrates a configuration of a lower shin textile tensioningsystem according to an exemplary embodiment of the invention. Theillustrated embodiment utilizes zipper closure 17 for the lower textileportions of the system; however, alternate embodiments could implementhook and loop, button, snap, or other similar fasteners to close andtighten the textile system. Independent cable reel tensioning system 20is implemented in the lower leg textile system 13 to adjust the level oftension across a broad surface area of the subject's lower leg andsoundly secure the orthotic system 100 to the subject. The cable isrouted in a single lower shin tensioning loop 25 originating andterminating at the reel 20 and routed around the leg such that it canaffect the slack between the lateral support structures 10 and the tibiaposterior structure 6 as well as the portion of textile around theposterior of the subject's calf. Alternate embodiments of the designcould implement a similar cable, textile, or webbing ratcheting furlingor reel system.

FIG. 6 illustrates a cross-sectional view of the thigh textilesuspension mechanism according to an exemplary embodiment. In theillustrated embodiment, the thigh textile suspension (and similar tibiasuspension system 9) keeps the thigh orthotic structure from coming intodirect contact with the subject's thigh. The force may be communicatedthrough the thigh textiles. This arrangement is of particular advantagefor active orthotic systems in which force is applied by an actuator toaide in leg extension for sit-to-stand mobility and ascending stairs,and to apply force to resist gravity to aide in stand-to-sit mobilityand descending stairs. The textile-based suspension is more advantageousthan the padding of traditional braces because active orthotics requiremovement of the brace to be communicated directly into movement of theleg. If there is too much padding, movement of the brace may onlycompress the padding and not effectively communicate the force to thesubject's leg. Use of a non-stretch fabric for the textile allows forceto be communicated to a large area of the subject's kg comfortably, yetthe fabric itself does not stretch allowing brace movement and legmovement to be closely coupled.

Embodiments are not limited to the techniques and materials discussedherein. The structural elements could be constructed of carbon fiber,fiberglass, aluminum, steel or another rigid material. The textileportion could be comprised of any compliant material including fabric,webbing or flexible plastics. An embodiment has been described for theknee, but braces with the same the multi-fit and mobility-assistancefeatures could be applied to other joints such as the ankle, elbow, hipand shoulder.

Throughout the foregoing specification, references to “one embodiment,”“an embodiment,” “an example embodiment,” indicate that the embodimentdescribed may include a particular feature, structure, orcharacteristic; however every embodiment may not necessarily include theparticular feature, structure, or characteristic. Moreover, such phrasesare not necessarily referring to the same embodiment. When a particularfeature, structure, or characteristic is described in connection with anembodiment, it is submitted that it is within the knowledge of oneskilled in the art to bring about such a feature, structure, orcharacteristic in connection with other embodiments, whether or notexplicitly described. Various changes may be made in the structure andembodiments shown herein without departing from the principles of thisdescription.

In the description as set forth above and claims, the terms “coupled”and “connected,” along with their derivatives, may be used. It should beunderstood that these terms are not intended to be synonymous with eachother. Rather, in particular embodiments, “connected” is used toindicate that two (2) or more elements are in direct physical orelectrical contact with each other. “Coupled” may mean that two (2) ormore elements are in direct physical or electrical contact. However,“coupled” may also mean that two (2) or more elements are not in directcontact with each other, but yet still cooperate or interact with eachother.

Embodiments of the invention may include various operations as set forthabove or fewer operations or more operations, or operations in an orderwhich is different from the order described herein. Throughout theforegoing description, for the purposes of explanation, numerousspecific details were set forth in order to provide a thoroughunderstanding of the invention. It will be apparent, however, to oneskilled in the art that the invention may be practiced without some ofthese specific details. Accordingly, the scope and spirit of theinvention should be judged in terms of the claims which follow as wellas the legal equivalents thereof.

What is claimed is:
 1. A multi-fit orthotic system using a textile-basedsuspension, the system comprising: a plurality of orthotic structurescomprising a linearly-aligned configuration and a non-linearly alignedconfiguration adapted to accommodate subjects with a non-linear legstructure; a plurality of independent suspension textiles, each coupledwith one of the plurality of orthotic structures, wherein eachindependent suspension textile conforms closely to a subject toaccommodate a wide range of subjects without a custom fit; a pluralityof independent tensioning systems including a cable reel tensioningsystem, each of the independent tensioning systems integrated into oneof the plurality of independent suspension textiles, each of theindependent tensioning systems configured to adjustably apply tension tothe associated suspension textile to affect fit of the multi-fitorthotic system to the subject, wherein the multi-fit orthotic system isconfigured to attach directly to the subject to provide assistance tothe subject including one or more of active mobility assistance,continuous passive motion and robotic therapy; and an actuatorintegrated with at least one of the plurality of orthotic structures andconfigured to deliver torque to the plurality of orthotic structures inthe linearly aligned or non-linearly aligned configurations.
 2. Themulti-fit orthotic system of claim 1, wherein the multi-fit orthoticsystem includes at most two points adapted to contact the subject toaccommodate the wide range of subjects.
 3. The multi-fit orthotic systemof claim 2, wherein the at most two points are adapted to engage aproximal thigh area of the subject and a distal shin area of thesubject.
 4. The multi-fit orthotic system of claim 1, further comprisingpneumatic cells integrated into each suspension textile of the pluralityof independent suspension textiles configured to statically inflate toadjust fit to the subject.
 5. The multi-fit orthotic system of claim 4,wherein the pneumatic cells are further configured to dynamicallyinflate and de-inflate by an inflation system to massage the subject'sleg through orthotic motion to assist in blood circulation.
 6. Themulti-fit orthotic system of claim 1, wherein the multi-fit orthoticstructure is capable of integrating with a linkage system to delivertorque to the subject's lower leg to facilitate extension motion.
 7. Themulti-fit orthotic system of claim 6, wherein the actuator is centermounted to one of the plurality of orthotic structures and the orthoticsystem is adjustable to fit the orthotic system to one or more of theright and left leg of the subject.
 8. The multi-fit orthotic system ofclaim 1, wherein the multi-fit orthotic structure is adapted to attachto the subject without requiring the orthotic structure to interfacedirectly with a knee region of the subject.
 9. A method of providingassistance to a subject comprising: attaching a multi-fit orthoticstructure to the subject's leg, the multi-fit orthotic structurecomprising an upper leg orthotic portion and a lower leg orthoticportion; conforming the multi-fit orthotic structure to the subject'sleg structure; and actuating a plurality of non-elastic independenttensioning systems integrated into the multi-fit orthotic structure toadjust fit to the subject, the plurality of independent tensioningsystems comprising a plurality of independent cable reel tensioningsystems, each coupled with a plurality of independent suspensiontextiles integrated into the orthotic structure, wherein at least one ofthe independent tensioning systems is configured to keep a portion ofthe multi-fit orthotic structure from coming into direct contact withthe subject.
 10. The method of claim 9, wherein the plurality ofindependent tensioning systems further comprises pneumatic cellsintegrated into the plurality of independent suspension textiles of theorthotic structure.
 11. The method of claim 10, further comprisinginflating the pneumatic cells integrated into the suspension textiles ofthe orthotic structure to further adjust fit to the subject.
 12. Themethod of claim 9, further comprising actuating the plurality ofindependent cable reel tensioning systems to adjust fit to the subject.13. The method of claim 9, wherein providing assistance to the subjectincludes one or more of providing active mobility assistance, continuouspassive motion, and robotic therapy.
 14. The method of claim 9, whereinthe multi-fit orthotic structure is attached to the subject withoutrequiring the orthotic structure to interface directly with a kneeregion of the subject.
 15. The method of claim 9, wherein the multi-fitorthotic structure is attached to the subject without requiring theorthotic structure to interface directly with lateral areas of a thighand calf of the subject.
 16. A multi-fit orthotic apparatus using atextile-based suspension, the apparatus comprising: a thigh orthoticstructure coupled with a thigh suspension textile; a lower leg orthoticstructure movably coupled with the thigh orthotic structure and coupledwith a lower leg suspension textile, the lower leg orthotic structurecomprising a non-linearly aligned configuration and a linearly alignedconfiguration relative to the thigh orthotic structure; wherein eachsuspension textile is configured to conform closely to a subject toaccommodate a wide range of subjects without a custom fit, and at leastone of the suspension textiles is configured to keep one of the orthoticstructures from coming into direct contact with the subject's leg; anactuator configured to deliver torque to the lower leg orthoticstructure in the non-linearly aligned configuration or linearly alignedconfiguration; and a footpad sensor system including at least onepressure sensor.
 17. The multi-fit orthotic apparatus of claim 16,wherein the orthotic apparatus is configured to couple directly with thesubject to provide one or more of exoskeletal support, mobilityassistance, continuous passive motion and robotic therapy.
 18. Themulti-fit orthotic apparatus of claim 16, further comprising pressuresensors placed in portions of each suspension textile to facilitatedetermining the level of pressure exerted in and around each of thesuspension textiles.
 19. The multi-fit orthotic apparatus of claim 16,wherein the multi-fit orthotic structure is adapted to attach to thesubject without requiring the orthotic structure to interface directlywith the knee region of the subject.
 20. A multi-fit orthotic apparatuscomprising: a thigh orthotic structure configured to be coupled to athigh of a subject; a lower leg orthotic structure movably coupled withthe thigh orthotic structure and configured to be coupled with a lowerleg of the subject; a tibia structure adjustably coupled to an anteriorportion of the lower leg orthotic structure, such that the position ofthe tibia structure may be adjusted relative to the anterior portion ofthe lower leg orthotic structure and the thigh orthotic structure, thetibia structure capable of moving to a linearly aligned configuration ora non-linearly aligned configuration relative to the thigh orthoticstructure; and an actuator adapted to deliver torque to the tibiastructure in the non-linearly aligned or linearly alignedconfigurations.
 21. The multi-fit orthotic apparatus of claim 20,wherein the adjustment of the tibia structure comprises a lateralrotation of the tibia structure relative to the lower leg orthoticstructure and the thigh orthotic structure, thereby allowing theorthotic apparatus to accommodate subjects with non-linear leg structurealignment.
 22. The multi-fit orthotic apparatus of claim 20, wherein theadjustment of the tibia structure comprises a proximal to distaladjustment of the tibia structure relative to the lower leg orthoticstructure and the thigh orthotic structure, thereby allowing theorthotic apparatus to accommodate different subjects of varying heights.23. The multi-fit orthotic apparatus of claim 20, wherein the adjustmentof the tibia structure comprises both a lateral rotation and a proximalto distal adjustment of the tibia structure relative to the lower legorthotic structure and the thigh orthotic structure, thereby allowingthe orthotic apparatus to accommodate subjects with non-linear legstructure alignment and different subjects of varying heights.
 24. Themulti-fit orthotic apparatus of claim 20, wherein the tibia structurecomprises a tibia anterior structure and a tibia posterior structure, atleast one of which is provided with at least one slot for permittingadjustment between the two structures.